Unit of Vector-borne Diseases and International Health, MIPI Department, Istituto Superiore di Sanità, Rome, Italy.
Euro Surveill. 2013 Jul 18;18(29):20535.
Starting from 1989 Italy experienced an increase of visceral leishmaniasis (VL) cases over a baseline of 10 to 30 cases reported annually. The number of cases peaked in 2000 and 2004 with more than 200 cases/year, and subsequently declined to reach on average one third of the 2000 peak value in the period after 2010. A retrospective analysis from 1982 to 2012 showed that the multi-annual epidemic consisted of major components including (i) an outbreak involving infants and immunocompetent adults in parts of the Campania region (southern peninsular Italy) and that appears to have declined naturally, (ii) a second outbreak affecting human immunodeficiency virus (HIV)-infected individuals throughout the country, that declined owing to the use of highly active antiretroviral therapies (HAART), (iii) a generalised increase of VL cases in immunocompetent individuals and patients affected by associated conditions other than HIV from endemic regions of peninsular and insular Italy (other than Campania), which was due to a geographical spreading of VL foci, with no major case-clusters or outbreak features. A minor component consisted in the appearance of a few autochthonous cases in formerly non-endemic areas, starting from the early 1990s. Epidemic determinants and reasons for VL decline in the Campania region remain largely unexplained, despite the information available on canine reservoir and phlebotomine vectors in Italy.
自 1989 年以来，意大利的内脏利什曼病（VL）病例数呈上升趋势，基线为每年报告 10-30 例。病例数在 2000 年和 2004 年达到峰值，每年超过 200 例，随后在 2010 年后的时期下降到 2000 年峰值的三分之一左右。1982 年至 2012 年的回顾性分析表明，多年流行由以下主要因素组成：（i）涉及那不勒斯地区（意大利半岛南部）部分地区婴儿和免疫功能正常成年人的爆发，似乎已经自然消退；（ii）第二次爆发影响全国范围内的人类免疫缺陷病毒（HIV）感染者，由于使用高效抗逆转录病毒疗法（HAART）而减少；（iii）除那不勒斯以外的意大利半岛和岛屿的地方性流行地区的免疫功能正常个体和患有相关疾病（除 HIV 以外）的患者的 VL 病例普遍增加，这是由于 VL 病灶的地理扩散所致，没有主要的病例聚集或爆发特征。一个较小的组成部分是，从 20 世纪 90 年代初开始，在以前非地方性流行地区出现了少数本地病例。尽管意大利有关犬类储存宿主和白蛉媒介的信息已经提供，但坎帕尼亚地区 VL 下降的流行决定因素和原因在很大程度上仍未得到解释。
